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DKA – initial management — RACP Paediatrics MCQ

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EasyEndocrineDKA – initial managementRACP Paediatrics

A 10-year-old with known type 1 diabetes presents with DKA (pH 7.15, glucose 28 mmol/L, ketones 5.5 mmol/L). He appears dehydrated but is haemodynamically stable. What is the most appropriate first step?

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Correct answer: B — 0.9% NaCl bolus 20 mL/kg

The first step in DKA management is fluid resuscitation with 0.9% NaCl bolus of 10-20 mL/kg. Per the RCH Melbourne DKA CPG (based on ISPAD 2022 guidelines), IV fluids should be commenced before insulin. Insulin infusion should be started 1 hour after commencement of fluid resuscitation.

Reference: RCH Melbourne – 2023 – Diabetic Ketoacidosis CPG; ISPAD – 2022 – DKA Consensus Guidelines